The Terms of the Debate

One of the dissenters' strongest arguments, which made an appearance in practically every published statement that any of them had made over the course of more than eight years, was that closure had been reached prematurely in 1984. A "probable cause" had been identified that was soon taken to be "the cause," yet no one bothered to prove it definitively. Instead, the world simply acted on what it took to be the truth. By the mid-1990s, however—particularly as a result of data from long-running cohort studies—the state of the evidence looked rather different. Indeed, one might even argue that the dissenters' challenge and the ensuing controversy had served to promote clearer argumentation on behalf of the HIV hypothesis. In that sense, ironically, the dissenters may have helped to reinforce the dominance of the position they opposed.

Does this mean that the end of the controversy was in sight? That would have been an overly hasty conclusion, and one that ignored recognized pitfalls along the path to closure in scientific controversies. In their consideration of the question of how scientific controversies end, H. Tristram Engelhardt and Arthur L. Caplan have noted the danger in assuming that complex disputes can be adjudicated through straightforward, rational means. The notion that a controversy can be "settled" presupposes prior agreement on "(1) how to acquire evidence relevant to the dispute and (2) how to reason with the evidence in order to reach a rationally defensible conclusion that will resolve the controversy." In fact, differing perceptions of what "the controversy" is and what sort of evidence might "settle" it are themselves often stakes in a controversy. This is all the more likely to be true,

Engelhardt and Caplan have observed, when "stakeholders in the debate belong to … different communities with different appreciations of the evidence at stake" or to "competing social groups" with opposing political and ethical agendas.^[99]

How does one prove disease causation? Without agreement on this basic question, there was little chance of consensus about the relation of HIV to AIDS. In the early 1980s, many researchers, including even Gallo, seemed to have Koch's postulates at least generally in mind as they sought to isolate the virus, to induce the syndrome in primates, and to trace transmission of AIDS through infected blood products (see chapter 2). But when challenged by Duesberg, researchers argued that Koch's postulates were rarely satisfied in practice, especially for viruses; and they pointed to well-known examples.

As Duesberg pressed his case, both sides moved toward the position that specific epidemiological evidence—especially controlled longitudinal data—is what could settle the question.^[100] But where epidemiologists such as Winkelstein insisted that the existing data from cohort studies already provided a definitive answer, Duesberg maintained that a meaningful cohort study had not yet been performed: The existing studies were created with the goal of studying the progression of "HIV disease." They were not set up to determine what causes AIDS, let alone to study drugs as a possible cause, and, Duesberg claimed, the data that had been collected about participants' drug use were superficial and inadequate. Neither Winkelstein nor the Vancouver group asked about drug use occurring as far back as ten years prior to entry into the study; nor had any of the cohort studies included blood tests for drugs, which Duesberg claimed were necessary to verify if the study participants were answering truthfully.^[101] From the perspective of Duesberg and his allies, these aspects of data collection rendered the cohort studies worthless in adjudicating between causal hypotheses. Duesberg's deconstruction of the cohort studies demonstrated clearly what science studies scholars have repeatedly argued: in situations of controversy, experiments alone cannot be expected to "settle" the dispute. "The problem with experiments," according to Harry Collins and Trevor Pinch, "is that they tell you nothing unless they are competently done, but in controversial science no-one can agree on a criterion of competence."^[102] Moreover, any experiment is—admittedly—an artificial stand-in for real-world conditions. Does the experimental situation adequately represent and capture reality? Nothing inherent in the experiment itself forces the observer to accept it as such.^[103]

Both sides remained convinced of the validity of their claims; each

side saw the other as dogmatically defending its position by means of a constant renegotiation of the rules. From Duesberg's standpoint, the defenders of orthodoxy were always "moving the goalposts" whenever its predictions were proved false; from the vantage point of the dominant position, the dissenters were forever cooking up newer and stricter criteria of proof that their opponents were then expected to meet. "Like a child who questions every answer with another 'why,' he plays a game which will never end until he says it is over," was how Martin Delaney characterized Duesberg's methodology in late 1992.^[104] But perhaps the real mistake was to imagine that there is one "scientific method" or set of "rules of evidence" upon which everyone could unproblematically agree.^[105] Indeed, if the controversy has demonstrated anything, it is that scientific "rules of the road" like Koch's postulates or epidemiological cohort data, far from being unchallengeable benchmarks, may be as subject to interpretation and debate as the empirical phenomena they are invoked to explain.

Most likely there is no scientific test that would settle the causation controversy to the satisfaction of all sides. A different sort of proof probably would spell the end of the controversy, however: if the AIDS establishment were to succeed in finding an impressively successful antiviral drug or vaccine, it is unlikely that anyone would continue to pay much attention to the dissidents. They would simply fade from the scene. This, however, is not entirely logical, for, as René Dubos has argued, it can be dangerous to infer medical etiology "backwards" from treatment effectiveness: "While drenching with water may help in putting out a blaze, few are the cases in which fire has its origin in a lack of water."^[106] Yet at its root the support for the dissenters stems precisely from disappointment with the establishment's lack of therapeutic success, as the dissenters themselves have been acutely aware. Michael Callen told a Canadian television program in 1989: "It seems to me that if … you've got a chemical that is anti-retroviral … and you give it to people who have a disease that you claim is caused by a retrovirus and they don't get better, that would tend to suggest—at a minimum—that something a lot more complicated than having or not having HIV is going on."^[107] The more time that has passed without a cure being discovered, the more persuasive has been the argument that the AIDS establishment has "produced nothing" and—by extension—their etiological hypothesis must be bankrupt. From a logical standpoint, this, of course, follows even less obviously than the converse claim that the existence of a successful treatment would verify the

causal hypothesis. But the argument has a rhetorical power that cannot be denied. "As long as there's no cure, this will lurk," Robert Gallo reflected in 1994.^[108]

Meanwhile, the struggle has gone on, and the HIV dissenters have continued to make the news. By now several of the principals have told their stories in book-length detail. Root-Bernstein's Rethinking AIDS: The Tragic Cost of Premature Consensus , published by Free Press, weighed in at 512 pages and included 100 pages of notes. It reviewed the anomalies in the HIV hypothesis, discussed a range of multifactorial theories of AIDS, and delved deeply into theories of autoimmune mechanisms.^[109] Lauritsen's The AIDS War: Propaganda, Profiteering and Genocide from the Medical-Industrial Complex , a reprinting of many of his articles, likewise ran nearly 500 pages.^[110] Ellison and Duesberg encountered more obstacles with their book, which was accepted but then dropped by two different publishers. By 1994 the book fell victim to a bitter feud that erupted between the two authors and led to a parting of the ways. Working alone, Duesberg finally published the book Inventing the AIDS Virus in 1996. In addition to 463 pages of new text, the book included reprints of several of Duesberg's scientific articles; it also featured a foreword by Kary Mullis. In this extensive review for the general reader, Duesberg summarized the views he had been putting forward for nearly a decade—not only on the HIV hypothesis and the drug-AIDS hypothesis, but on the status of the field of virology and the politics of science in general.^[111]

The ranks of the dissenters were depleted in December 1993 by the death of Michael Callen, who had lived with AIDS for nearly twelve years and played a central role in a range of activist projects.^[112] Other dissenters have continued to engage public attention. Notable occasions have included the appearances by Duesberg, Kary Mullis, and Philip Johnson at a special panel of the annual meeting of the Pacific Division of the American Academy for the Advancement of Science; a Florida physician's public self-injection with apparently HIV-infected blood to draw attention to "the greatest scam ever perpetrated"; and a freshman Republican Congressman's attempt to force government scientists at the NIH and CDC to consider the view that HIV does not cause AIDS.^[113]

Perhaps most noteworthy, however, was a high-profile "Special News Report" called "The Duesberg Phenomenon," published in Science in late 1994 and taking up an extraordinary eight pages of the

premier journal.^[114] "Because the Duesberg phenomenon has not gone away and may be growing," wrote Jon Cohen, the AIDS reporter for Science and the author of the news report, "Science has decided this was a good time to examine Duesberg's main claims." Cohen's strategy was to tackle Duesberg's arguments head-on; in a series of sidebars, he considered each of the critical test cases. Although scrupulous in presenting Duesberg's views, the article suggested that Duesberg was wrong on all counts: being HIV positive was the key variable associated with HIV-related illness for hemophiliacs; Koch's third postulate had been satisfied by the accidental infection of three laboratory workers, all of whom developed symptoms of immune suppression prior to taking any antiviral drugs; and large, recent studies of extended AZT use showed no evidence that the drug caused AIDS.^[115] Not surprisingly, this intervention ignited yet another wave of publicity: though Cohen may have intended exactly otherwise, his article propelled the Duesberg phenomenon onward. Indeed, a long article in The Scientist published in March 1995, which led off with the special report in Science , was entitled "A Controversy That Will Not Die: The Role of HIV in Causing AIDS."^[116]

Years after the publication of his article in Cancer Research , Peter Duesberg has settled in for the long haul. The HIV controversy has become his life; his office on the Berkeley campus is the war room of a campaign waged simultaneously on multiple fronts. Duesberg maintains a frenetic pace, juggling reporters and visitors between poring over the latest AIDS publications and preparing his latest rebuttals. Though he might not agree with much that Anthony Fauci has to say, he would doubtless concur with one prediction that the NIH scientist made back in 1989: "I am probably going to be answering Peter Duesberg for the rest of my life."^[117]